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Article ; Online: Serum creatinine in predicting mortality after paraquat poisoning

Wei Huang / Zheng Zhang / Yuan-Qiang Lu

PLoS ONE, Vol 18, Iss 2, p e

A systematic review and meta-analysis.

2023 Volume 0281897

Abstract: Although the prognostic value of blood creatinine levels in patients with paraquat (PQ) poisoning has been studied for a long time, the results are still controversial. Therefore, we performed the first meta-analysis to comprehensively assess the value ... ...

Abstract	Although the prognostic value of blood creatinine levels in patients with paraquat (PQ) poisoning has been studied for a long time, the results are still controversial. Therefore, we performed the first meta-analysis to comprehensively assess the value of blood creatinine in predicting the prognosis of patients with PQ poisoning. We searched PubMed, EMBase, Web of Science, ScienceDirect, Cochrane Library, China National Knowledge Infrastructure, China Science and Technology Journal Database, and China Online Journals to identify all relevant papers published up to June 2022. Data were extracted for pooled analysis, heterogeneity testing, sensitivity analysis, publication bias analysis, and subgroup analysis. Ultimately, 10 studies involving 862 patients were included. The I2 of diagnostic odds ratio (DOR), sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of this study were all greater than 50%, which showed the existence of heterogeneity in this study, and a random effects model was used for the combination of the above five effect sizes. Pooled analysis showed a high predictive value of blood creatinine for prognosis of PQ poisoning [pooled DOR:22.92, 95% confidence interval (CI):15.62-33.65, P < 0.001]. The combined sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were 86% (95% CI: 0.79-0.91), 78% (95% CI: 0.69-0.86), 4.01 (95% CI: 2.81-5.71), and 0.17 (95% CI: 0.12-0.25), respectively. Deeks publication bias test revealed there was publication bias. Sensitivity analysis showed no significant differences in the estimates of impact. Serum creatinine is an effective predictor of mortality in patients with PQ poisoning.
Keywords	Medicine ; R ; Science ; Q
Subject code	310
Language	English
Publishing date	2023-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Machine learning models for early prediction of potassium lowering effectiveness and adverse events in patients with hyperkalemia

Wei Huang / Jian-Yong Zhu / Cong-Ying Song / Yuan-Qiang Lu

Scientific Reports, Vol 14, Iss 1, Pp 1-

2024 Volume 10

Abstract: Abstract The aim of this study was to develop a model for early prediction of adverse events and treatment effectiveness in patients with hyperkalemia. We collected clinical data from patients with hyperkalemia in the First Hospital of Zhejiang ... ...

Abstract	Abstract The aim of this study was to develop a model for early prediction of adverse events and treatment effectiveness in patients with hyperkalemia. We collected clinical data from patients with hyperkalemia in the First Hospital of Zhejiang University School of Medicine between 2015 and 2021. The least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression were used to analyze the predictors on the full dataset. We randomly divided the data into a training group and a validation group, and used LASSO to filter variables in the training set. Six machine learning methods were used to develop the models. The best model was selected based on the area under the curve (AUC). Shapley additive exPlanations (SHAP) values were used to explain the best model. A total of 1074 patients with hyperkalemia were finally enrolled. Diastolic blood pressure (DBP), breathing, oxygen saturation (SPO2), Glasgow coma score (GCS), liver disease, oliguria, blood sodium, international standardized ratio (ISR), and initial blood potassium were the predictors of the occurrence of adverse events; peripheral edema, estimated glomerular filtration rate (eGFR), blood sodium, actual base residual, and initial blood potassium were the predictors of therapeutic effect. Extreme gradient boosting (XGBoost) model achieved the best performance (adverse events: AUC = 0.87; therapeutic effect: AUC = 0.75). A model based on clinical characteristics was developed and validated with good performance.
Keywords	Medicine ; R ; Science ; Q
Subject code	610
Language	English
Publishing date	2024-01-01T00:00:00Z
Publisher	Nature Portfolio
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Lethal diquat poisoning manifests as acute central nervous system injury and circulatory failure

Jia-Ning Zhou / Yuan-Qiang Lu

EClinicalMedicine, Vol 52, Iss , Pp 101609- (2022)

A retrospective cohort study of 50 cases

2022

Abstract: Summary: Background: The mortality rate of patients with diquat (DQ) poisoning is extremely high due to insufficient understanding of DQ-induced injury. This study aimed to summarize the characteristics of DQ poisoning as well as analyse the correlation ... ...

Abstract	Summary: Background: The mortality rate of patients with diquat (DQ) poisoning is extremely high due to insufficient understanding of DQ-induced injury. This study aimed to summarize the characteristics of DQ poisoning as well as analyse the correlation between plasma DQ concentration and patient outcomes, thus providing a new strategy for diagnosis and treatment. Methods: This single-centre retrospective cohort study was conducted at the Emergency Department of the First Affiliated Hospital, Zhejiang University School of Medicine, China, between Oct 9, 2019 and March 10, 2022. 50 patients, whose plasma or urine samples tested positive for diquat and negative for paraquat by high performance liquid chromatography-tandem mass spectrometry, were included in the study. Findings: The mortality rate of acute DQ poisoning was 25 (50%) of 50. Compared with the survival group, the death group presented significantly higher initial plasma DQ concentration (Cp1), aspartate aminotransferase, alanine aminotransferase, serum creatinine, and creatine kinase-MB (P < 0.05). We found that six (24.0%) patients died of central nervous system injury, six (24.0%) patients died of refractory circulatory failure, and 13 (52.0%) patients died of central nervous system injury combined with circulatory failure. Receiver operator characteristic curve analysis showed that the area under the curve of Cp1 was 0.967 (95% CI: 0.911, 1.000), and the cut-off value was 3516.885 ng/mL (sensitivity, 90.9%; specificity, 96.0%). Interpretation: Lethal DQ poisoning is primarily associated with serious brain and vascular injury, as well as a high rate of mortality. Further research into the mechanisms of refractory circulatory failure and central nerve system damage could help reduce mortality. Funding: There are no funding sources to declare.
Keywords	Diquat poisoning ; plasma diquat concentration ; Central nervous system injury ; Circulatory failure ; Neuroimaging ; High-performance liquid chromatography-mass spectrometry ; Medicine (General) ; R5-920
Subject code	610
Language	English
Publishing date	2022-10-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Serum vitamin D levels and acute kidney injury

Huanran Zhang / Yan Jiang / Nan Shi / Yuan-Qiang Lu

Scientific Reports, Vol 12, Iss 1, Pp 1-

a systemic review and meta-analysis

2022 Volume 8

Abstract: Abstract Numerous researches have evaluated the prevalence and clinical outcome of vitamin D deficiency in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). But the quantitative vitamin D status in acute kidney injury (AKI) ... ...

Abstract	Abstract Numerous researches have evaluated the prevalence and clinical outcome of vitamin D deficiency in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD). But the quantitative vitamin D status in acute kidney injury (AKI) patients and its relationship with prognosis remains controversial. We conducted this systemic review and meta-analysis to assess the quantitative difference of vitamin D status, including serum 25(OH) D and 1,25(OH)2D levels, between AKI patients and non-AKI controls, and further explore whether vitamin D status can be clearly correlated with the mortality of AKI. Major databases, including PubMed, Web of Science and EBSCO, were searched until 1st September 2021. All published observational studies related to vitamin D and AKI According to predefined inclusion and exclusion criteria were extracted. Meta-analyses were performed using Review Manager 5.3.5. Four studies including five cohorts were included with a total of 413 patients. The serum 25(OH)D levels showed no statistically significant difference in AKI patients and non-AKI controls. On the other hand, the serum 1,25(OH)2D levels were significant lower in AKI patients than in non-AKI controls (MD = − 17.79, 95% CI = − 32.73 to − 2.85, P = 0.02). As for the relationship between serum vitamin D status and AKI patients’ mortality, we were unable to give a consistent conclusion based on current limited and conflict study results. Our meta-analysis suggested that serum 1,25(OH)2D levels, rather than 25(OH)D, is significantly lower in AKI patients. The relationship between vitamin D status and clinical outcome of AKI remains controversial based on current evidence. Future comprehensive studies are required to confirm these relations and to elucidate potential mechanisms.
Keywords	Medicine ; R ; Science ; Q
Subject code	610
Language	English
Publishing date	2022-11-01T00:00:00Z
Publisher	Nature Portfolio
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Effects of Hypertonic Saline and Hydroxyethyl Starch on Myeloid-Derived Suppressor Cells in Hemorrhagic Shock Mice under Secondary Bacterial Attack

Jiu-Kun Jiang / Liang-Jie Hong / Yuan-Qiang Lu

BioMed Research International, Vol

2020 Volume 2020

Abstract: Objectives. The primary target is to reveal whether the resuscitation with hypertonic saline (HTS) or hydroxyethyl starch (HES) would have different effects on the myeloid-derived suppressor cell (MDSC) count and monocytic MDSC (M-MDSC)/granulocytic/ ... ...

Abstract	Objectives. The primary target is to reveal whether the resuscitation with hypertonic saline (HTS) or hydroxyethyl starch (HES) would have different effects on the myeloid-derived suppressor cell (MDSC) count and monocytic MDSC (M-MDSC)/granulocytic/neutrophilic MDSC (G-MDSC) rate in the peripheral blood, spleen, and bone marrow nucleated cells (BMNC) in a controlled hemorrhagic shock mouse model under secondary Escherichia coli bacterial infection attack, comparing to resuscitation with normal saline (NS) in 72 hours. Method. After hemorrhagic shock with bacteremia, which is induced by Escherichia coli 35218 injection, the mice were distributed into control, NS, HTS, and HES groups. The peripheral blood nucleated cells (PBNC), spleen single-cell suspension, and bone marrow nucleated cells were collected. The flow cytometry was used to detect the MDSC, M-MDSC, and G-MDSC. Result. In PBNC, after resuscitation with NS, the MDSC was continuously higher, while the rate of M-MDSC/G-MDSC were continuously lower (P<0.05). In HTS, the MDSC varied, higher at 24 and 72 hours (P<0.05), the M-MDSC/G-MDSC were continuously lower (P<0.05). In the spleen, resuscitation with HTS, the M-MDSC/G-MDSC were continuously lower (P<0.05). In BMNC, after resuscitation with HES, the M-MDSC/G-MDSC were lower at 24 and 72 hours (P<0.05). Conclusion. In mouse hemorrhagic shock model with bacterial infection, the resuscitation with NS, HTS, or HES induced difference changes in MDSC and M-MDSC/G-MDSC, which were time-dependent and organ-specific. Resuscitation with crystalloid, like NS or HTS, showed longer effects on the MDSC and M-MDSC/G-MDSC in peripheral blood; while HTS has a longer effect on M-MDSC/G-MDSC in the spleen, HES has a stronger impact on the differentiation regulation of MDSC to G-MDSC in the bone marrow.
Keywords	Medicine ; R
Subject code	630
Language	English
Publishing date	2020-01-01T00:00:00Z
Publisher	Hindawi Limited
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Prospect of using deep learning for predicting differentiation of myeloid progenitor cells after sepsis

Wei-Shuyi Ruan / Jia Xu / Yuan-Qiang Lu / Yi Cui

Chinese Medical Journal, Vol 132, Iss 15, Pp 1862-

2019 Volume 1864

Keywords	Medicine ; R
Language	English
Publishing date	2019-08-01T00:00:00Z
Publisher	Wolters Kluwer
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Immune dysfunction following COVID-19, especially in severe patients

Cong-Ying Song / Jia Xu / Jian-Qin He / Yuan-Qiang Lu

Scientific Reports, Vol 10, Iss 1, Pp 1-

2020 Volume 11

Abstract: Abstract The coronavirus disease 2019 (COVID-19) has been spreading worldwide. Severe cases quickly progressed with unfavorable outcomes. We aim to investigate the clinical features of COVID-19 and identify the risk factors associated with its ... ...

Abstract	Abstract The coronavirus disease 2019 (COVID-19) has been spreading worldwide. Severe cases quickly progressed with unfavorable outcomes. We aim to investigate the clinical features of COVID-19 and identify the risk factors associated with its progression. Data of confirmed SARS-CoV-2-infected patients and healthy participants were collected. Thirty-seven healthy people and 79 confirmed patients, which include 48 severe patients and 31 mild patients, were recruited. COVID-19 patients presented with dysregulated immune response (decreased T, B, and NK cells and increased inflammatory cytokines). Also, they were found to have increased levels of white blood cell, neutrophil count, and D-dimer in severe cases. Moreover, lymphocyte, CD4+ T cell, CD8+ T cell, NK cell, and B cell counts were lower in the severe group. Multivariate logistic regression analysis showed that CD4+ cell count, neutrophil-to-lymphocyte ratio (NLR) and D-dimer were risk factors for severe cases. Both CT score and clinical pulmonary infection score (CPIS) were associated with disease severity. The receiver operating characteristic (ROC) curve analysis has shown that all these parameters and scores had quite a high predictive value. Immune dysfunction plays critical roles in disease progression. Early and constant surveillance of complete blood cell count, T lymphocyte subsets, coagulation function, CT scan and CPIS was recommended for early screening of severe cases.
Keywords	Medicine ; R ; Science ; Q ; covid19
Subject code	610 ; 616
Language	English
Publishing date	2020-09-01T00:00:00Z
Publisher	Nature Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Multiorgan Drug Action of Levosimendan in Critical Illnesses

Jian Pan / Yun-Mei Yang / Jian-Yong Zhu / Yuan-Qiang Lu

BioMed Research International, Vol

2019 Volume 2019

Abstract: Cardiotonic drugs mainly include digitalis, catecholamines, phosphodiesterase inhibitors, and calcium sensitizers, which have been successively discovered and applied in clinical practice. However, there are only a few new drugs available in this field, ... ...

Abstract	Cardiotonic drugs mainly include digitalis, catecholamines, phosphodiesterase inhibitors, and calcium sensitizers, which have been successively discovered and applied in clinical practice. However, there are only a few new drugs available in this field, and the selection is very limited. Digitalis, catecholamines, and phosphodiesterase inhibitors increase myocardial contractility by increasing intracellular concentrations of cyclic adenosine monophosphate (cAMP) and Ca2+, and this increase in intracellular calcium ion concentration enhances myocardial oxygen consumption and causes arrhythmia. For these reasons, the research focus on positive inotropic agents has shifted from calcium mobilization to calcium sensitization. Intracellular calcium sensitizers are more effective and safer drugs because they do not increase the intracellular concentration of calcium ions. However, only three calcium sensitizers have been fully developed and used in the past three decades. One of these drugs, levosimendan, has multiple molecular targets and exerts its pharmacological effects by not only increasing myocardial contractility, but also enhancing respiratory muscle function and liver and kidney protection, and it is useful for patients with severe sepsis and septic shock. Recently, more than 60 randomized controlled clinical trials of levosimendan have been reported; however, these clinical trials have occasionally shown different findings. This article reviews the research progress of levosimendan in critical illnesses in recent years.
Keywords	Medicine ; R
Subject code	610
Language	English
Publishing date	2019-01-01T00:00:00Z
Publisher	Hindawi Limited
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Predictive value of the maximum serum creatinine value and growth rate in acute paraquat poisoning patients

Meng-Xiao Feng / Yu-Ning Li / Wei-Shuyi Ruan / Yuan-Qiang Lu

Scientific Reports, Vol 8, Iss 1, Pp 1-

2018 Volume 7

Abstract: Abstract This retrospective and a single-center study evaluated the prognostic value of the maximum serum creatinine value (maxCr) and the maximum serum creatinine growth rate (Vmax) after paraquat (PQ) ingestion. One hundred and seventy-one patients ... ...

Abstract	Abstract This retrospective and a single-center study evaluated the prognostic value of the maximum serum creatinine value (maxCr) and the maximum serum creatinine growth rate (Vmax) after paraquat (PQ) ingestion. One hundred and seventy-one patients with PQ poisoning were treated with a uniform protocol. Demographic variables, clinical manifestations, relevant laboratory data, maxCr and Vmax of all patients were recorded and calculated. The time after PQ ingestion of maxCr and Vmax were also recorded. Vmax and MaxCr exhibited statistically significant differences between the survivor (n = 53) and death (n = 118) groups. Vmax appeared earlier in the death group than the survivor group. Regard to the receiver operating characteristic (ROC) curve analysis, Vmax had an AUC of 0.861 (95% CI, 0.801–0.921) and the optimal cut-off value of 6.21 μmol/(L·h) (sensitivity, 76.3%; specificity, 81.1%). MaxCr had an area under the curve (AUC) of 0.821 (95% CI, 0.752–0.889) and the optimal cut-off value of 225.5 µmol/L (sensitivity, 82.2%; specificity, 67.9%). The comparison of the AUC in the two parameters showed no significant difference, but Vmax appeared earlier than maxCr. Based on binary logistic regression analysis, MaxCr and Vmax both showed strong predictive powers for evaluating the prognosis of acute PQ poisoning patients.
Keywords	Medicine ; R ; Science ; Q
Subject code	630
Language	English
Publishing date	2018-08-01T00:00:00Z
Publisher	Nature Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Time-dependent haemoperfusion after acute paraquat poisoning

Hao-Ru Wang / Jian Pan / An-Dong Shang / Yuan-Qiang Lu

Scientific Reports, Vol 7, Iss 1, Pp 1-

2017 Volume 8

Abstract: Abstract Early haemoperfusion (HP) therapy has been found to be very effective in acute paraquat (PQ) poisoning, but the effective rescue window is still uncertain. Demographic data and the type of therapies administered of 621 patients were included as ... ...

Abstract	Abstract Early haemoperfusion (HP) therapy has been found to be very effective in acute paraquat (PQ) poisoning, but the effective rescue window is still uncertain. Demographic data and the type of therapies administered of 621 patients were included as confounding factors in this retrospective study. After receiver operating characteristic curve analysis and intra-group/subgroup analysis, the initiation of glucocorticoid therapy within 3 hrs of exposure with a second treatment given <21 hrs after exposure, HP initiated within 4 hrs of exposure with a second treatment given <20 hrs after exposure, the appearance of pulmonary lesions ≤8 days after exposure and six other variables were used in a multiple analysis. The strength of positivity of the PQ urine test on admission, HP initiated within 4 hrs of exposure with a second treatment given <20 hrs after exposure, the appearance of pulmonary lesions ≤8 days after exposure, and stage III AKI on admission were independent factors of survival probability. HP therapy for acute PQ poisoning was the main therapeutic intervention investigated in this study. Outcomes were time dependent, and the crucial factor was the initiation of therapy within 4 hrs of PQ poisoning followed by a second treatment within 20 hrs.
Keywords	Medicine ; R ; Science ; Q
Subject code	610
Language	English
Publishing date	2017-05-01T00:00:00Z
Publisher	Nature Portfolio
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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